title: Subdural haematoma after endoscopic skull base surgery: case report and lesson learned.
abstract: We report a case of a left fronto-temporo-parietal subdural haematoma that emerged as a complication of an endonasal endoscopic resection of a sinonasal adenocarcinoma of the left ethmoidal region. During the first surgical intervention, following oncological principles, the dura mater above the ethmoidal plate was removed and a skull base plasty was performed. In the post-operative phase a massive cerebrospinal fluid leak was observed and a revision duraplasty was performed the following day. Subsequently the patient was discharged on day 8 with no signs of CSF leakage. At the three month follow-up MR examination a subdural haematoma was observed and then treated by the neurosurgeon in a standard fashion. The collection was quite asymptomatic and discovered accidentally. We strongly advise the role of early post-op neuroimaging in every patient undergoing skull base procedures. We maintain that a massive CSF leak, that causes a significant reduction of intracranial pressure, should be managed as a surgical emergency, in order to reduce the risk of subdural haematoma.
authors.affiliation: Azienda Ospedaliero Universitaria Pisana, Pisa, Italy. iacopodallan@tiscali.it
authors.forename: I
authors.initials: I
authors.lastname: Dallan
authors.forename: R
authors.initials: R
authors.lastname: Lenzi
authors.forename: L
authors.initials: L
authors.lastname: Muscatello
authors.forename: M
authors.initials: M
authors.lastname: Bignami
authors.forename: P
authors.initials: P
authors.lastname: Battaglia
authors.forename: P
authors.initials: P
authors.lastname: Castelnuovo
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology; D004724:Endoscopy / Q000009:adverse effects*; D005004:Ethmoid Bone / Q000473:pathology / Q000601:surgery; D006408:Hematoma, Subdural / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011183:Postoperative Complications / Q000473:pathology* / Q000628:therapy; D019291:Skull Base / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000601:surgery; D014057:Tomography, X-Ray Computed